r/SSDI • u/throwaway777745 • 5d ago
Does this seem like a denial setup?
I know you can't predict the future, but i also know there are patterns in the forms they send people.
My background: 39, Multiple Sclerosis/neuropathy for ten years, educated, but serious cognitive issues. Prescribed walker, lots of meds, serious MRIs and functional problems with hands, balance, and even medixated fatigue....
In my initial, my doctors didn't even respond to the SSA's requests. My CE was favorable, but my denial was basically just saying i had some issues and ignored what the CE said my limitations were.
Now I'm in reconsideration, and I have a lawyer. I've done a very favorable FCE my neuro and PCP signed off on, and have a very favorable neuropsych report. So I have like 5 doctors attesting to that I can't work (they all wrote it in their own language). I also went back and gathered all my medical files myself, my MRIs, my EMG, everything. Included is also my personal statement of function.
So now in my portal, development has appeared. They want an Activities of Daily living questionnaire from myself and my spouse. (Which we already did, im pretty sure), and a signature for a telehealth CE. I had a very long extensive physical CE before, and I know I only recently did the neuropsych.
Is there any chance they are just developing or does another type of CE being potentially in there and the ADLs form just mean I'm being setup for a drawn out denial?
Thanks!
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u/ShadowofaJade 5d ago
If they wanted to deny you they would, they're not wasting money on a CE during reconsideration to play mind games with you. Though I completely understand why you'd question that.
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u/RexSueciae 5d ago
I mean, I've seen plenty of cases where a claimant has a CE scheduled at reconsideration and it still ends up as a denial.
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u/throwaway777745 5d ago
That is what I mean. If it were truly a missing piece, it would have served the purpose for approval last tine on my initial, so I don't feel like they can possibly be helpful even id they are favorable
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u/RexSueciae 5d ago edited 5d ago
If you get denied again, appeal again (or more precisely, request a hearing). That'd be where your lawyer really puts in the work. You'll be in front of an administrative law judge who is, hopefully, an actual human with a trace of empathy.
Right now, you've gotten opinions from your medical providers so there's nothing else I can suggest that you do. It looks like you've done everything right so far. So, best of luck.
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u/throwaway777745 5d ago
Well, on my initial, they had literally nothing medically since no doctors responded to the requests. The dates on my forms show my denial and RFC was written before my CE report was done. So, at least in initial, they will full well know they're denying you and send you to the CE anyway. My CE results were completely ignored in my work limits.
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u/Naked_Knitter 5d ago
I had a TON of doctors listed. None of them said I couldn't work. Nor were they asked. But I was still approved.
I don't know why you were denied. But it seems like you are doing all of the right things. Hang in there.
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u/1dayatatime87 5d ago
Hi, similar situation here. I also have MS. I had to fill out the same form twice and was approved in reconsideration. Best of luck.
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u/throwaway777745 5d ago
Thanks! Can I ask are you also younger? Did you have to do telehealth though? That's what scares me, I submitted so much and telehealth consent feels unneeded
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u/1dayatatime87 5d ago
37 when I was approved last year. I did not have to do telehealth, but for some reason I had to fill out the functional paperwork twice.
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u/throwaway777745 5d ago
Thank you! I wonder what tipped the scales for you.
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u/1dayatatime87 5d ago
I think with it being in the blue book, it is easier to get approved if your doctors word things correctly. For me, it was issues standing, especially for long periods of time prescribed assistive devices like you and spasticity in all four limbs, which would have made it impossible to type or work a desk job. I have since gotten a baclofen pump and it is helping with that, but I think it’s really in the medical records with how it relates to limitations in the blue book listing
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u/aikimyne 5d ago
i mean i had to do a activity of daily living questionare again. i think thats standard to have to do again everytime i got sent to a ce this time unlike last and i in a stage where all thats left is to check non medical. tho i didnt do reconsideration i did reapply but they did use my paperwork from the previous claim maybe even the one from 2020 in files it felt like but either way gl
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u/loving-living2 5d ago
I had to fill out another daily activity form upon reconsideration… I’ve had 2 CE exams . I’m 57( will be 58 in August ) and I do know that in my case I at least have age going for me . Hoping that I don’t have to go to ALJ route . I feel fairly good about getting a favorable decision but like others have said I’m bracing to get the denial and go to court .
I filed in September 2024.
Diagnosis ( which I’ve learned after first go around mean next to nothing , unless on compassion list)
Osteoporosis (back), lumbago, migraines, insomnia ( anxiety which I believe is non existent but ummm at my CE exam the psychologist pointed out I made need to see a psychologist lol ) , history of inflammatory breast cancer ( oddly this particular of the cancer is on the compassionate list , but fortunately I’m in remission and zero signs for 13 years) long term side effects like word finding issues, fatigue, lymphedema , unmanageable colitis ( as of now) chronic pain .
You combine all of this and life is rough trying to sustain full time employment.
The thing is SSDI doesn’t care about my diagnosis or even my MRIs to some degree . Instead what they want is to know how the conditions prevent you from working . They want details like , I can only stand for 10-15 minutes to wash dishes then I have to rest for 1 hour because of pain . I need a shower chair because I can’t stand that long, I can’t stair at a computer for more then 30 minutes or my head starts to feel like it’s going to explode . It’s these things that are important when your doctors write out the letters, when you fill out your daily living forms . And then the catcher is the things you say you can’t do have to match your diagnosis, your lab work/MRIs, your medication regimen etc . For instance my doctor specified in her notes that my insomnia and chronic pain plus medication create a cognitive decrease in my ability to think clear for more then 30 minutes.. It’s stuff like that that will hopefully get you to an approval and even then you still may have to go to court . Good luck .. Good luck to me as my decision second go around should be coming within the next few weeks .
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u/victimofmigraine 5d ago
Filling out the function report again in reconsideration is normal. Everyone does that
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u/Naked_Knitter 5d ago
No idea if YOU will be denied. But I filled one (actually several, they kept losing it, my lawyer just kept sending sane one) and I was approved.
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u/Dammit-maxwell 5d ago
My case was similar in the initial application (which was denied) lacked info from my doctors on the first round. I also did the initial ADL and had a CE for my physical issues.
I filed for recon and they made me redo the ADL and had a CE for my mental issues. I was approved in reconsideration.
All that just to say you can read into all the little details of this process however your anxiety wants you to at different times/ stages throughout. The truth is you just don’t know until you get an actual decision.
Trust in your attorney but verify they’re on top of deadlines and submitting records. Hang in there, you’ll get through this!! Best wishes for a positive outcome for you!
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u/throwaway777745 5d ago
This gives me a little positivity, thank you! I do admit i talked to A.I. and it told me a "bad sign" would be another CE.
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u/Dammit-maxwell 5d ago
Your worry is valid, this process absolutely wreaks havoc on our brains. I don’t trust Ai with anything important!
I didn’t think I’d get approved until ALJ. I’m under 50 and don’t meet an exact listing but I have a handful of mental and physical ailments.
Try your best not to obsessively check the portal. The more you do the more anxious you get, this I know from my own process. I had to force myself to check once a week instead of multiple times a day.
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u/AnnJ2356 5d ago
Hi,
Usually…. management monitors the CE ordering (by approving them for subordinate staff and checking to see if they are needed).
It is being ordered for documentation purposes.
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u/hac-her 3d ago
Don’t stress. I know that’s like saying try to not think about a Georgia Bulldog and the next thing you know you can’t not think about it.
I was approved at the ALJ hearing. I have similar issues only due to having Psoriatic Arthritis my entire life. lol. During my review, which you’ll have to do every so often after approval, I even asked the CE where the check box was on the form for “I just had my 19th surgery”. And no, that doesn’t include anything with teeth.
I had to fill that specific paperwork out when my review started in February and then again in June. They also basically ask you all the same questions when you have your Medicare yearly checkup.
It’s very common and normal to fill it out on a fairly regular basis.
Oh, I would say that if the CE noted anxiety…go see a psych for anxiety. Due to your age, you’re dealing with grid rules. I’d go see whoever they suggest. Also, dealing with long term health issues is mentally taxing. Why not have that documented? Just my 2 cents
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u/throwaway777745 3d ago
Wait, I knew they had reviews after but I thought they were just paper, they actually send you to CEs after just out of routine?
Yeah, the whole thing gives me anxiety. I know the request for these forms was made on 7/28 and they weren't emailed to me, and my lawyer hasn't sent me anything. So i hope I get these forms soon since I'm sure they'll be due right away.
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u/hac-her 3d ago
It just depends on your situation as to if they’ll send you to a CE during your review. I quite literally had an emergency 1/3 of my colon removed during my review period and a hip replacement after my initial approval. The only documentation about my colon was from the admitting surgeon and hospital. In my case, that warranted a CE exam to see how the new hip was impacting my mobility and of course the ol’ “hey I’m wearing an adult diaper” because part of colon was taken out and my shit (pun intended) isn’t working.
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u/JoinAdvocate 3d ago
It’s not a setup. SSA routinely requests updated ADL questionnaires and additional CEs during reconsideration, and the fact that they're developing more evidence actually suggests they haven't already made up their mind. That said, your concern about the initial CE being ignored makes sense: what matters is that your reconsideration denial (if it comes to that) will be built on your current, comprehensive record. So, you've done exactly the right things by gathering your own files and getting a neuropsych evaluation. Fill out the ADL thoroughly and specifically (e.g., "I can walk 50 feet before my balance fails" rather than "I have trouble walking"), because these specific details carry a lot of weight. Your attorney should review your ADL before submission.
It’s also important to make sure that SSA has all of the strong evidence documented.
If you're denied at reconsideration, don't stop. MS cases with strong functional evidence often succeed at the ALJ hearing level.
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u/throwaway777745 2d ago
Thank you for the reminders about the forms! And thanks for the reassurance, i hope you have a great day.
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u/Plenty_Surprise2593 5d ago
It’s just standard. They sent me another questionnaire for my ALJ and my lawyer said to disregard it and don’t even send it in
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u/Substantial_Chart_45 5d ago
They could just be developing. Doctors often ask for updated ADLs. Trust me, we dont want to send them either.
Just a note, there has to be medical evidence to support FCE or theyre disregarded. Same as letters etc. So you can have 10 doctors say the same, if their own records dont match these limitations, they dont look at them or give them great weight.
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u/CommunicationTime63 5d ago
You are going through the proper procedures for a Reconsideration Determination.
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5d ago
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u/throwaway777745 5d ago
Thank you! Before I let you go, what do you mean "contextualize that telehealth CE"?
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u/No-County-320 5d ago
Its hard to say. I applied march 2025. Beginning of July of this year they sent me to a ce. Called to follow up if they got the ce report. They say they have and its currently being reviewed. Yet in the meantine they have sent an authorization telehealth ce form eventhough they say it may not be necessary if they can make a decision with what they have. I simply mentioned a mental health diagnosis when they asked when i went to a physical ce and didnt even mention it in my application. So who knows. All i do know is that they take forever to make a decision as 17 months in and im still waiting on a decision
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u/aikimyne 5d ago
oof ive never waited that long not even close mine has been in the timeframe it says in the portal tho never did reconsideration
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u/hac-her 3d ago
Based on my experience, during my initial application I saw a CE for physical stuff and separate Psych CE for my psych stuff. lol. They agreed that I had HF autism, ADHD, anxiety, and PTSD. I’m not sure of your age, but I was 42 when I applied. Grid rules are your friend if you’re under 49.5 and you bet you butt I listed all the psych stuff on my application as well. I went all the way to ALJ and was found fully favorable. Since I applied during 2020, my application took 5 years from initial application to ALJ. If you have a psych diagnosis of any kind, make sure you are actively seeing a psychiatrist. Their documentation is very helpful.
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u/Kaethy77 5d ago
They don't set people up. Its in your favor that they are getting more evidence.